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HomeMy WebLinkAboutBuilding Permit #116-15 - 36 BUCKLIN ROAD 7/31/2014 r• .f " f tiORTH BUILDING PERMIT 3?O��t(f lD „6 q�rOL TOWN OF NORTH ANDOVER ° o APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: �1� I ACHUS IMPORTANT: Applicant must complete all items on this page LOCATION C �j K L�I A) I2 . w t a w $ in PROPERTY�OWNER' AS 1� ' Print ' fi MAP NO; `PARCEL: 1�` ZONING DISTRICT: s Histone District ° yes no° # Machine Shop Village yes,,,, TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building XOne family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial �R:Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑`Septic b Well fi W. Floodplain . ❑Weilands V1latershed District ' w.. 0,Water/Sewer STRIP EXIST I ►AJC ASPI-IA Cr SHIN6tcs AND (ZEPLACC VVITN 30 YEAR AP-CH ITC c700AL .4 IcEfwA 7-C#e SOIECD ,q,✓0 AXW F(-9SH itir Identification Please Type or Print Clearly) OWNER: Name: Q 5 E-C AA GH ,�N I Phone: ;81-232- 26 -C,6 Address: �6 �3UCKG/N /2Q IV AN O✓fIe W O/e�y5 CONTRACTOR Name Phor a- % f� rt 9f3-y 7PS/ ° ; Address xR a: $ # Frz a �y /0q, CfJMMINGS' CE.t 7 %7,1, 5VII-e 226 G /3Ei/E,QC Y r,Mq 019'/S Supervisor's Construction License: r Ex "Date Q1 Home"lmprovement'License, 4: /12 ` ` Expo Date ° Ad- A L6 x A. ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 5, 1-75- 00 FEE: $ U _71- Check No.: 1174 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guar my fund Signature of Agent/OwnerL- =77�: Sgnature.of contractor :r _._ ,00,z�� + BUILDING PERMIT o` "°oT" qti TOWN OF NORTH ANDOVER o� APPLICATION FOR PLAN EXAMINATION `' Permit No#: Date ReceivedreD 4 ��SS acHus���y Date Issued: IMPORTANT: Applicant must complete all items on this page x z37 It YV 1PROPEROlY �WNER' t MAPPARCEL .� fiZONING�DISTRICgT�Historic#Dfstnct r � yesrno - ��.` � � � - yMachineShop Village •yes ono TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition 0 Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other i 0 Septic, ®Well ❑tFloodplain Wetlantls ® WatershedDistnct Water/Sewer ,�T ._, -. �..k--.k r = �.,-. *. �.y. a'� .-.. .u ._ KT..a ,h ac :; .•s r : DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: yx�€: �^r .tR. - a.,.•7 3 4 y�k ,,. ,�'r%-.-�S �r�:� ontractor� .3� ick. e w. r a a 4` c+.,:r c�`"--"� 3#'`.'ems-'r• x y:,� '�' "�Cw a '+l r<nw-��-w�.s�a- = ,e� - , 'k � ._--.-,.... .F � ...--.....�� a �..�,k- ..e cv� �•:�.-� �:' .:ter..Y! ye , Horne l_mprosyemen -License ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of°Agent�Ownera ': - . °, , ; 3`,Signature of contractor, �� = _ ? x' .:'rsc.�-�.r.-•Y,ss,..-+c�asrn^�K:K:_c--rr�nn..., r - Location No. l —7 Date 911 . TOWN OF NORTH ANDOVER Certificate of Occupancy p y $_ Building/Frame Permit Fee $ Foundation Permit Fee Other Permit mit Fee TOTAL $ Check# �� B ding Inspector i c .. Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments I 1 Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street tr mss': �.n;,.-�• .� r=.. f FIRE�DEPARTMENT Temp iyesJo L"-ocatetl:aJ `r.,` .a N11 t X124 Main+S.treet Y ,-Pr F,ireDepartments�gn1Rure/date z � R ='"aa""������-�-.�� +,+gar=,ms.� ar--- -�'= ",7 a^�rg- �€ •r Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA — (For department use) i i ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit Li Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract o Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan o Workers Comp Affidavit i o Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Cons r t uctionSin le and Two Family) � 9 Y) ❑ Building Permit Application, o Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract --- o Mass check Energy Compliance Report o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application.. Doc:Building Permit Revised 2014 F pORTh s Town of aAndover O No. y _ T Z _� y �( � �h ver, Mass, q, T O COCK ICNIWICK S V BOARD OF HEALTH Food/Kitchen PERMIT LD Septic System ATHIS CERTIFIES THAT ..................... BUILDING INSPECTOR has permission to erect ........ �' .V►.C�..IL.� N Foundation p .................. buildings on .. ... l�.......... ,�. � Rough to be occupied as ......... . .... ...... .�� . ............................ ...... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough Service ...... ............ � BUILD... ... .. Final ING...... .......INSPECTOR.......... GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises - Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: 36 1-?X9C1n/ /zn is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. - Also, note Permits are required under Fire Prevention laws Chapter 148 Section I 0A. The debris will be disposed of in: -5'7-57 Tiow (Location of Facility) S re ermit Applicant Date I A� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDO/Y'"") 4/22/14 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemen s. PRODUCER CONTANAME: Carmen Cocca Cocca Insurance Associates Inc PHONE 781 245-0888 FAX No: (781) 246-3926 dba Water Street Insurance Age E-MAJLADDRESS: carmen@getinsurancehere.com 27 Water Street INSURE S AFFORDING COVERAGE NAIC# Wakefield, MA 01880 INSURERA:Essex INSURED INSURER B:Travelers Betterbuilt Enterprises LLC INSURER C:Evanston 100 Cummings Ctr Ste 226-G INSURERD: Beverly, MA 01915 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER M/DD/Y MIr11DD/YYYY LIMITS A GENERALLIABILITY 3DS5526 1/11/14 1/11/15 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTEDPREMISES(Ea occuom ce) $ 50,000 CLAIMS-MADE FXI OCCUR MED EXP(Arty one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OPAGG $ 2,000,000 X POLICY PRO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT T accid rd $ ANYAUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE TOS HIRED AUTOS er accident $ $ C UMBRELLA LIAB }{ OCCUR XONJ451413 1/11/14 1/11/15 EACH OCCURRENCE $ 1,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTION B VYORKERSOM COMPENSATION AND EMPLOYERS'LIABILITY 6HUB5B94898—A-14 4/25/14 4/25/15 WCSTATU- 0TH-ANY $ OFFICER/MEMB REXCLUDEDDXCCUTIVE Y/N ER 7 N/A E.L.EACH ACO DENT $ 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1 000,000 If YYes,describe under DESCRIPTIONOFOPERATIONSbelow IE.L.DISEASE-POLICYIIM IT $ I -000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) The Workers Compensation policy does not provide coverage for DENNIS DROGGITIS & EVANGELOS LIAPIS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CERTIFICATE ISSUED FOR YOUR ACCORDANCE WITH THE POLICY PROVISIONS. COMPANY UPON REQUEST FOR BIDDING PURPOSES ONLY AUTHORIZED REPRESENTATIVE Carmen Cocca ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The AC ORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: Massachusetts -Department of Public Safety Board} of Building Regulations and Standards ds Construction Supervisor License:CS4)84795 .i.I.` EVANGEIAS LIA,M F,.. 12 STONE STREET I s DANVERS MA IR Expiration Commissioner 05/1312015. License or registration valid for individul use only office of consumer Affairs&Busidess Regulation before the expiration date. If found return to: ME IMPROVEMENT CONTRACTOR Type: Office of Consumer Affairs and Business Regulation Wegistration: 110 Park Plaza-Suite 5170 piration: $!81016, Ltd Liability Corporati p- Boston,MA 02116 n� BETTER BUILT ENTERP_RIS S=ILG EVANGELOS LIAPIS. 100 CUMMINGS CENTIR[ Ul- E 2 9't'/ERLY,MA 01915 Undersecretary alid w' ut signature I I /5 I , BETTER ` Contractor License#CS 094612 B U I L# '"1 HIC#160616 :"r'f�t��Z1YT'a'iiY'�1 � '► Aseem Ghani 36 Bucklin Rd. North Andover,MA 01845 Ph:781-272-2658 Email:asimny_@hotmail.com June 10,2014 Dear Aseem,The following estimate is for the roof installation.for the property located at the above address. The following paragraphs describe the work that will be performed. Roof Installation Procedure: Strip existing roof on the entire house Inspect decking for any rotten or damaged areas Replace any rotted or broken roofing boards at a'cost of$5.,00/LF for ledger board or$70.00/sheet for%"plywood Install 6 feet of ice&water on all leading edges,valleys&/or transitions Install 15 pound felt paper to cover rest of roof Install an 8-inch drip edge on all eave and rake edges.Color::White- Install new vent pipe flanges Install new 30 year Architectural shingles,fastened by nails .* Install a ridge vent system on the main peak of the house Home owner to choose color of shingles Color- Additional Specifications: _ - ' Dumpster to be placed next to house or garage All work will be done in a professional manner,and timely basis Please cover all items in attic to protect from falling dust and debris .- We are not responsible for any of the cracks that may°arise in any walls or ceilings ! 4r, We will remove all of the job related debris Thorough daily job site cleaning and upon job completion Our price includes the cost of the building permit obtained at the North Andover Building Department Cost for Labor&Material to Install New Roof: $5,175,00 i Additional carpentry will be billed at an hourly rate of$45/hr plus any necessary material Payment Terms:.30%deposit,30%work in progress and 40%upon completion Warranty: Bett Yt Enterprises LLC guarantees all work performed for a period of two years. If any problems occur we will cover the cost fall abor to correct the problem and meet the customer's WtisfactCh. MA License#160616 Dennis Dr ggitis Aseem Ghani BetterBui Cons ction Homeowner The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations I Congress Street, Suite 100 4 Boston,MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): &677 7612&C)1 L7_ 4A)r R S'Cf 46C Address: X00 CUMM/N6S CCAJt-6e SC,MC 226 City/State/Zip: &6VF&y MI 9 0/g/ S- Phone#: 9?S' 99�- y7S/ Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with 5 4. ❑ I am a general contractor and I employees(full and/or part-time). * have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ®'Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.: 9. E] Building addition required.] 5. E] We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs p insurance required.] t c. 152, §1(4),and we have no� employees. 13.0 Other emP Y to o workers' comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: ��p!✓E t`E(L Policy#or Self-ins. Lic. #:G 1401350118301 — A - !14 Expiration Date: y 2S l 'S Job Site Address: 3 t; a V C k-U JV P-0 A City/State/zip: IV, ANDOVER M lA O IS q S Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains a na ' of perjury that the information provided above is true and correct. Sip-nature: Dat e: Phone#: 978, '71 C, 4-75 1 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: